Framework for reducing restrictive interventions

Key messages

Reducing restrictive practices, such as restraint and seclusion, is essential to provide safe mental health services.

Restraint and seclusion must only be used after all less restrictive options have been considered and found to be unsuitable.

The framework helps staff plan and design services that reduce and try to eliminate restrictive interventions.

The planning framework Providing a safe environment for all helps mental health services and professionals to plan and design services that reduce – and where possible eliminate – the use of restrictive interventions.

Reducing restrictive practices

Reducing restrictive practices, such as restraint and seclusion, is essential to provide mental health services that are safe places for all consumers, visitors and health staff.

Restraint and seclusion must only be used after all less restrictive options have been considered and found to be unsuitable, in order to protect the health and safety of all people using mental health services.

Evidence shows that restrictive interventions can re-traumatise people with past experiences of trauma and impede the development of trusting relationships between people receiving care and clinicians.

Framework principles

Providing a safe environment for all is underpinned by a comprehensive review of the research and evidence relating to restrictive interventions. It is based on a series of core principles, which ensure that:

consumers, their support networks and health staff are treated with respect and dignity

difficult and challenging behaviour is managed in ways that show decency, humanity and respect for individual rights

restrictive interventions are used as a last resort after all less restrictive options have been tried or considered and found to be unsuitable

workplace practices are informed by recovery-oriented practice, trauma-informed care and supported decision making

programs to reduce restrictive interventions receive effective governance and ongoing monitoring of local action plans and processes to ensure their effective implementation.

Using the framework

There is an increasing body of good practice and evidence to support health services in reducing restrictive practices. Providing a safe environment for all contains ‘snapshots’ of good practice and links to guidelines and resources that can be used to support planning, decision making, review and quality assurance.

The framework also provides ‘reflection questions’ to assist managers and health staff to assess their own practices, identify strengths and weaknesses in their systems and capabilities, and plan local responses to reduce their reliance on restrictive practices.

The literature review, Reducing restrictive interventions, provides illustrations of therapeutic interventions that can assist with the de-escalation of aggressive behaviours and the reduction of restrictive interventions. This should assist with training strategies for staff to reduce the use of seclusion and restraint.

Recommendations for reducing restrictive interventions

Providing a safe environment for all provides a number of recommendations to help organisations reduce their use of restrictive interventions. Services should:

undertake an internal assessment of the use of the three care practices – recovery-oriented practice, trauma-informed care and supported decision making – and establish a change management process in line with the framework

develop a workforce plan outlining alternative strategies for staff to manage aggressive behaviours and actions for leaders to engage and support others in this initiative

review the way data is used to inform practice and monitor progress

review governance structures to provide clear roles and responsibilities and promote a culture of learning and enquiry

develop a program of activities to reduce restrictive practices and engage consumers and carers to ensure these activities are grounded in real-life experiences

adapt processes and policies to embed reflective practice and critical reviews of incidents as they arise.